Thursday, February 28, 2013

Head of Smoking Cessation Treatment of UPenn Health System Speaks Out Against Smoker Discrimination Policy

The head of smoking cessation treatment for the University of Pennsylvania Health System - Dr. Frank Leone - has spoken out against the recently announced ban on the hiring of nicotine users, arguing that it may not actually decrease health care costs.

In an article published by Newsworks, Dr. Leone called the policy "regressive" and suggested that job applicants who smoke are likely to hide their cigarette use, making it subsequently impossible for them to join smoking cessation programs without risking job termination.

According to the article: "The
head of the University of Pennsylvania's smoking treatment program said
the health system's new policy not to hire smokers is a bad one. The clinics and hospitals within the system will no longer hire
tobacco users starting July 1 of this year, according to a Penn Medicine
careers website. It's an effort to improve employee health and cut down
on healthcare costs. New hires will be required to self-report and will
face disciplinary action, up to termination, if they are caught in a
lie. Dr. Frank Leone, director of Penn's Comprehensive Smoking Treatment
Program, doesn't think it will improve health or cut down on healthcare
costs. "People have dealt with this for a very long time, desperately
wanting to quit, unable to quit, confused about why they can't quit,"
Leone said of smokers. Then, in order to get a job they really need, he said they will have to say they don't smoke. "It's hard to imagine a person doing anything but really just hiding
the fact that they're a smoker," Leone said. "And once that happens,
particularly in a healthcare institution, the chances that they'll go
and seek care for the problem go down considerably in my mind." Smokers in hiding will still be employed, but won't take advantage of
employer-offered smoking cessation programs, and healthcare costs will
not be impacted, Leone argued.

The Rest of the Story

Dr. Leone presents an intriguing argument. It is likely that many applicants who smoke will simply hide that private behavior from the employer. However, once hired, they will have to keep that behavior hidden because if exposed, it could cost them their jobs. Therefore, they are unlikely to take part in smoking cessation programs or other employer-offered incentive programs to help them quit smoking.

In the same article, Lewis Maltby, head of the National Workrights Institute, offers a compelling argument against UPenn's employment discrimination policy: "What
you do in your own home on your own time, is none of your boss's
business. Everything you do in your private life affects your healthcare
costs. What you eat. Do you consume alcohol? How do you get around? Do
you drive a car or ride a bicycle? And, heaven forbid, you should ride a
motorcycle. If it's ok to tell people they can't smoke
in their own home because it impacts company medical costs, there is
nothing in your private life that isn't subject to employer control."

There is yet another argument against this policy which I didn't mention in yesterday's commentary. The policy applies not just to smokers but to all nicotine users. This means, presumably, that if a smoker is trying to quit smoking by using nicotine replacement therapy or electronic cigarettes, he or she is not eligible for employment. And if an ex-smoker has actually quit smoking successfully using NRT or electronic cigarettes, he too is ineligible for employment if he is continuing to use those replacement products.

This is ludicrous because it punishes smokers who are trying to quit. The policy, then, isn't about health but about an abstinence-only ideology.

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About Me

Dr. Siegel is a Professor in the Department of Community Health Sciences, Boston University School of Public Health. He has 32 years of experience in the field of tobacco control. He previously spent two years working at the Office on Smoking and Health at CDC, where he conducted research on secondhand smoke and cigarette advertising. He has published nearly 70 papers related to tobacco. He testified in the landmark Engle lawsuit against the tobacco companies, which resulted in an unprecedented $145 billion verdict against the industry. He teaches social and behavioral sciences, mass communication and public health, and public health advocacy in the Masters of Public Health program.